A Gentiva Presentation By:

Jocelyn Delgado, PT

Expiration Date for Awarding Contact Hours Contact hours for nursing credit will be

awarded for this activity until February 28, 2015

This in-service is intended for educational purposes only. This program does not constitute medical or professional advise

Information presented is not a substitute for judgement of the health professional

Gentiva Health Services Inc. is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation

Gentiva Health Services, Inc. is approved by the California Board of Registered Nursing, Provider Number CEP-3445 – for 1.2 contact hours.

This educational activity has been awarded 1.0 ANCC contact hours

Gentiva Health Services, Inc is approved by Florida Board of Nursing, Provider Number 50-808 – for 1.0 contact hour.

Gentiva Health Services, Inc. is Iowa Board of Nursing Approved Provider 351. Completion of this course is awarded 1.2 contact hours.

In order to receive full contact hour credit(s) for this CE activity, you must: Be register for this activity and complete Attendance

Form Be present no later than five (5) minutes after starting

time Remain until the scheduled ending time Complete Participant Evaluation (found in packet) Present Participant Evaluation to receive your CE

certificate

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The planners and presenters (nor spouse/domestic partner) of this educational activity have disclosed no healthcare related conflicts of interest, commercial interests, or has received any related financial relationships/support.

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Accredited status does not imply endorsement by Gentiva Health Services, Inc. or the American Nurses Credentialing Center (ANCC) of any commercial products displayed in conjunction with this activity.

This continuing education activity does not relate to any product used for a purpose other than that for which it was approved by the Food and Drug Administration (FDA)

The author(s)/reviewers of this course state that: Neither I nor my spouse/domestic partner have any

healthcare related conflicts of interest, commercial interests, or have any related financial support within the past 12 months

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The accredited status of this course does not imply endorsement by the ANCC

The learner will understand the definition of a fall and be able to verbalize the effect of a fall on the patient, caregiver and healthcare costs.

The learner will be able to list the common types of falls, the hazards of frequent falls and the internal and external factors related to falls.

The learner will differentiate between various risk assessments tools and explain the importance of risk assessment related to fall prevention.

The learner will name interventions and how to apply interventions for fall reduction.

The learner will discuss interventions to reduce injuries related to falls.

Fall - A sudden uncontrolled, unintentional, downward displacement of the body to the ground or other objects. Excluding falls resulting from violent blows or other

purposeful actions Un-witnessed Fall - a person/patient is found

on the floor and neither the patient nor anyone else knows how he or she got there.

15% of reason for for Emergency Room visits for patients 65 and older 2

One out of three adults, aged 65 and older fall each year 1

Fall related deaths for 65 or older population have been on the rise over the past decade 1

The most common cause of traumatic brain injuries (TBI) occur from falls. Cause of 46% of fatal falls 1

In 2002, Direct medical costs related to falls totaled $2 billion for fatal falls 1

$19 billion for non fatal falls Men fall 49% more than often than women

Men are more likely to die from falls 1

Fall related fractures are more than twice as high for women as for men 1 In one year, an average of 15% of falls occurred in the hospital 3

A person who has experienced a fall, is 8x more likely to fall again within a year.

Toileting Transferring Walking to the Bathroom Transferring from Chair Walking in hallways Household walking (without A.D) Rolling out of bed Attempting to get out of bed Overall, greatest number of falls occur at

night.

Past Falls is a predictor of the Future

Fear of Falling Compensatory strategies Postural compensation Behavioral compensation Avoidance Behavior

FEAR OF FALLING

Focus on Fall Prevention/Reduction Reduction of Injury.

All contribute highly to falls and associated fractures Nocturia/ incontinence Urinary Frequency Urge Incontinence

INTRINSIC FACTORS (PATIENT CONDITIONS)

EXTRINSIC FACTORS (ENVIRONMENT)

ANTICIPATED FACTORS History of Falls (greatest risk factor) Incontinence Cognitive/Psychological Status Depression/Anxiety Disorders Mobility/strength/balance Dizziness/Vertigo/Vestibular

Disorders Postural Hypotension Age (>65) Osteoporosis Musculoskeletal changes (OA,RA) Fear/anxiety associated with falls Low vision

ANTICIPATED FACTORS

Footwear, inappropriate, lack of Low toilet seat Wheels in beds or chairs Restraints Prolonged length of stay Unsafe equipment Broken equipment Beds left in high position Environment (wet floor, floor glare,

cluttered room, poor lighting, inadequate handrail support, monochromatic color schemes, loose cords or wires,

Pets

INTRINSIC FACTORS (PATIENT CONDITION)

EXTRINSIC FACTORS (ENVIRONMENT)

Unanticipated Seizures

Cardiac Arrhythmias'

CVA or TIA

Syncope

“Drop Attacks”

Unanticipated Individual reactions to

medications

SINGLE INTERVENTION Move it or Lose it!!!

Physical Therapy Balance training and Exercise (HEP) Tai Chi

Home Safety Assessment Medication Withdrawal Hip Protectors

MULTIFACTORIAL INTERVENTIONS Multidisciplinary Health and Environmental screening and intervention. PT, OT SN

Environmental modification Removing slip hazards Furniture Rearrangement Adequate lighting Non slip bath mats Stair rails Grab bars next to toilet and shower Raised toilet seats Visual Aides

Patient Education Self Advocacy CDC Questionnaire Begin a regular exercise program Routine Medication Review by HCP Routine Vision Checks Make Home Safer

Restraints Side Rails Toileting Programs DME Alarms

TUG Test: > 14 seconds associated with high fall risk >30 seconds predictive of requiring ambulation devise and

being dependent in ADL’s

5 X sit to stand Normal = 10 sec. Fall Risk = >14 – 15 secs

Functional Reach Test >10 inches = Low Fall Risk 6” to <10” = Risk for falling 2x greater than normal <6” = Risk of Falling 4x greater than normal Unwilling to reach = Risk of falling 8x greater than normal < 6” = limited functional balance 10+ = Adequate functional Balance

Missouri Alliance of Home Care – MAHC 10+ = Adequate functional Balance

Morse Scale Hendrich Scale –

Nursing assessment that addresses anticonvulsant and benzodiazopene medications; dizziness; mobility; depression;

Berg Balance Test

16 functional questions with Max score of 56. 41-56 = independent however <45 = may be greater risk for

falling; with Hx of Falls and BBS <51, or No History of falls and BBS < 42 is

predictive of falls Score of <40 on BBS associated with almost 100% fall risk.

Tinnetti Balance Assessment Tool

Overall Score of 28 with Balance Score = 16 and Gait Score+ 12. 25-28 = low fall risk 19 – 24 = Medium fall risk < 19 = high fall risk.

CDC STEADI (Stopping Elderly Accidents, Deaths & Injuries) Tool Kit for Health Care Providers. • Making Fall Prevention Part of Your Practice • Get Background Information about Falls • Case Studies • Patients Encouragement, Resources and Referrals • Algorithm for Fall Risk Assessment and interventions

www.cdc.gov/injury/steadi

Check Your Risk for Falling Please circle “Yes” or “No” for each statement below. Why it matters Yes (2) No (0) I have fallen in the past year. People who have fallen once are likely to fall again. Yes (2) No (0) I use or have been advised to use a cane or walker have been advised to use a cane or walker to get around safely. People who may already be more likely to fall. Yes (1) No (0) Sometimes I feel unsteady when I am walking. Unsteadiness or needing support while walking are signs of poor balance. Yes (1) No (0) I steady myself by holding onto furniture when walking at home. This is also a sign of poor balance. Yes (1) No (0) I am worried about falling. People who are worried about falling are more likely to fall. Yes (1) No (0) I need to push with my hands to stand up from a chair. This is a sign of weak leg muscles, a major reason for falling. Yes (1) No (0) I have some trouble stepping up onto a curb. This is also a sign of weak leg muscles. Yes (1) No (0) I often have to rush to the toilet. Rushing to the bathroom, especially at night, increases your chance of falling. Yes (1) No (0) I have lost some feeling in my feet. Numbness in your feet can cause stumbles and lead to falls. Yes (1) No (0) I take medicine that sometimes makes me feel light-headed or more tired than usual. Side effects from medicines can sometimes increase your chance of falling. Yes (1) No (0) I take medicine to help me sleep or improve my mood. These medicines can sometimes increase your chance of falling. Yes (1) No (0) I often feel sad or depressed. Symptoms of depression, such as not feeling well or feeling slowed down, are linked to falls. Total______ Add up the number of points for each “yes” answer. If you scored 4 points or more, you may be at risk for falling. Discuss this brochure with your doctor.

American Geriatric Society Guidelines for Fall Mgmt. SUMMARY OF RECOMMENDATIONS

SCREENING AND ASSESSMENT 1. All older individuals should be asked whether they have fallen (in the past year). 2. An older person who reports a fall should be asked about the frequency and circumstances of the fall(s). 3. Older individuals should be asked if they experience difficulties with walking or balance. 4. Older persons who present for medical attention because of a fall, report recurrent falls in the past year, or report difficulties in walking or balance (with or without activity curtailment) should have a multifactorial fall risk assessment. 5. Older persons presenting with a single fall should be evaluated for gait and balance. 6. Older persons who have fallen should have an assessment of gait and balance using one of the available evaluations.

7. Older persons who cannot perform or perform poorly on a standardized gait and balance test should be given a multifactorial fall risk assessment. 8. Older persons who have difficulty or demonstrate unsteadiness during the evaluation of gait and balance require a multifactorial fall risk assessment. 9. Older persons reporting only a single fall and reporting or demonstrating no difficulty or unsteadiness during the evaluation of gait and balance do not require a fall risk assessment. 10. The multifactorial fall risk assessment should be performed by a clinician (or clinicians) with appropriate skills and training. Please visit this link for the full guideline: http://americangeriatrics.org/health_care_professionals/clinical_practice/clinical_guidelines_recommendations/prevention_of_falls_summary_of_recommendations

Accidental falls are serious problems among older adults. Falls are the leading cause of fatal and non-fatal injuries in people 65 and older. One- third of seniors will suffer a fall and 60% of those falls occur in the home. A fall or injury can lead to loss of interest or pleasure in doing daily activities and decreased socialization, along with feelings of hopelessness and depression. These issues can contribute to future falls and a decline in independence. This can lead to displacement of living situation and inability to remain in their home. While falls can seem like common occurrences for Seniors, they should not be considered a normal consequence of aging.

Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS) [cited 2006 Aug 21 and Oct 9]. Available from URL: www.cdc.gov.ncipc/wisqars

Andrew Kochera. Falls Among Older Persons and the Role of the Home: An Analysis of Cost, Incidence, and Potential Savings from Home Modification. Public Policy Institute, American Association of Retired Persons 2002.

VHA NCPS Falls Tool Kit (May 2004) Mills, P.D. et.al.: Root Cause Analysis. Using Aggregate Root Cause

Analysis to Reduce Falls and Related Injuries. Jt. Comm. J on Qual and Patient Safety. 31:21-30, Jan. 2005

Lewis C. Balance, Gait Test Proves Simple Yet Useful. P.T. Bulletin 1993; 2/10;9-40.

Shobha, S. Rao, MD, University of Texas Southwestern Dallas Texas. Am. Fam. Physician, 2005 Jul1; 72(01): 81-88

Questions and Answers

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